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Abstract
Preterm labour defined as onset of delivery between 20 and 37 completed weeks. Preterm delivery is the most important single cause of perinatal mortality and morbidity. Preterm premature rupture of membranes (pPROM) is present in up to 40% of cases of premature labour.
The main risk factor for preterm delivery is a previous preterm delivery. Causes of preterm delivery in descending order are; infection, iatrogenic and idiopathic. The best predictor of preterm labour is transvaginal ultrasonographic measurement of cervical length and it replaces the digital examination nowadays.
Complications of (pPROM) include; oligohydramnios, chorioamnionitis ,placental abruption and postpartum heamorrage.
There is an inverse correlation between the latency period and gestational age. As the gestation advances, the relative risk of infectious morbidity becomes greater than that of prematurity and immediate delivery is favored. Whilst at earlier gestations conservative management is associated with a better outcome. At any gestation, evidence of maternal or fetal sepsis would be an indication for delivery.
Maternal steroids and prophylactic antibiotic (macrolide) following pPROM reduce maternal infection after delivery and neonatal infection. Although it remains controversial to use prophylactic tocolysis in cases of pPROM, it is known that tocolysis is probably not indicated in cases of documented fetomaternal infection.
Our study was conducted on fifty pregnant female patients randomly recruited from the antenatal clinic of El-Shatby Maternity University hospital fulfilled our inclusion criteria and signed a well informed consent to declare their agreement to be in this study as agreed upon by the ethical committee.
There are several types of tocolytic agents but no tocolytic agent is completely effective and safe, The most widely used one and the one used in our study is nifedipine , multiple tocolyis better to be avoided
All cases are almost matched in their general characteristics. All cases received tocolysis in the form of nifedipene slow released tablets 20 mg, corticosteroids in the form of dexamethasone intramuscularly 12 mg every 12 hours for 48 hours and clindamycine 300 mg orally
After prospective observation of our cases for two days, we found that thirty five cases (seventy percent of cases) did not progress into preterm labour pains, while only fifteen cases (thirty percent of cases).This mean that prophylactic tocolysis saved cases from progression into preterm labour. This finding was matched with many studies worldwide.
After analysis of different variables from cases histories we noticed direct relationships between gestitonal age and duration of preterm premature rupture of membranes with the incidence of preterm labour pains within 48 hours of tocolysis. On the other hand, there were inverse relationships between the parity with that incidence.
By analysis of other variables we found a direct relation between the C-reactive protein level and the incidence of preterm labour pain. But the amniotic fluid index and the transvaginal ultrasonographic cervical length had inverse relationships with that incidence.